When you have a broken tooth beneath your gum line or when there's not enough structure to hold a dental crown, crown lengthening becomes necessary.

Both restorative and cosmetic reasons can lead to getting a gum lift or reshape. Based on your needs, you can choose either a functional (restoration) or esthetic (appearance) lengthening procedure.

Your local periodontist can help with these procedures. In this blog, we'll cover the basics of dental crown lengthening its impact on your smile and dental health, the benefits, and much more!

What is Crown Lengthening?

At its core, tooth cap lengthening is a surgical process that is done to expose more of the tooth, by reshaping or reducing gum tissues and the underlying bones around one or more teeth. The goal is to increase the visible portion (the “clinical crown”) of the tooth so that either a repair can be made or the smile can look its best.

Some of this work is done by or under the supervision of a trained periodontist. In practical terms, this means the gum line is moved a bit back (apically repositioned). If required, a small amount of bone is removed to let the tooth structure sit higher than the gum and bone structures. It sounds intimidating, but when it’s done properly, recovery is manageable and the long-term benefits are significant.

Functional Uses of Crown Lengthening

Let us begin with the functional aspect, commonly known as “repair and restoration”, to get this process done:

• Access to sub-gum damage: Sometimes a tooth has decay, a crack, or a filling extension that goes below the gum line. Without exposing more tooth structure, the repair might fail, or the restoration may not be stable. Crown lengthening gives the dentist room to work.

• Proper restoration margins & retention: For a crown or cap to last, it needs a good margin and enough tooth above the bone for strength. If the margin ends too close to or under the bone, problems like gum inflammation or bone loss can occur. This dental procedure creates that clearance.

• Maintain healthy gum/bone relationships: There is a term called the biologic width (or supracrestal tissue attachment), or the space of soft tissue that needs to exist between the bone and the restorative margin for healthy gums. If a restoration infringes this zone, the tissue may respond poorly. Tooth cap lengthening helps restore that balance.

• Saving a compromised but restorable tooth: In cases where a tooth is broken near the gum line, a tooth might otherwise be considered lost. But with crown lengthening, you may be able to restore it instead of extracting.

So if your periodontist says you need a tooth cap extension for a functional reason, they’re talking about preparing the tooth and surrounding structure for a successful restoration.

Esthetic Uses of Crown Lengthening

Now let’s talk about beauty. Many people seek crown lengthening because they dislike how their gums and teeth look when they smile. Here is the aesthetic aspect:

• Gummy smile: If too much of your gum shows when you smile (and your teeth look short), then cap lengthening can reposition the gum line. This will expose more tooth surface and create a more balanced and attractive smile.

• Uneven gum line/short anterior teeth: Sometimes the front teeth appear too short because the gums cover more of them than ideal. Crown lengthening can expose more of the natural tooth, making the teeth appear longer and more proportionate.

• Improving smile symmetry and appearance: Beyond just showing more teeth, the gum contours can be made more even, which enhances the overall smile.

In these cases, aesthetics are the primary driver. These teeth may function fine, but the patient might want a better look. The procedure, however, is very similar to the functional version, although the planning and the area treated (front teeth/gums) may have extra considerations.

Functional vs Esthetic: Where They Overlap

It’s important to note that functional and aesthetic uses are not always completely separate. In many cases, crown lengthening serves both purposes. For example, a damaged front tooth may need more exposed structure (functional) and at the same time, the gum height and contour might be adjusted for appearance (aesthetic).

Before the procedure, proper evaluation is key: the anatomy of the tooth, the gum phenotype (thin or thick), bone levels, aesthetic zone vs back teeth, and long-term periodontal health. A practitioner (often a periodontist) is responsible for mapping it out.

What to Expect When in Gum Lift / Reshaping

If you plan to get a crown lengthening, for either functional or aesthetic reasons, then here is what you can expect:

1. Consultation & planning: Your provider will examine the tooth/teeth, take X-rays, measure gum and bone levels, discuss options and explain whether this is for function, aesthetics, or both.

2. Surgery: Under local anesthesia (and sometimes sedation), the gum tissue is lifted and if required bone is recontoured. The tissues are repositioned and sutured.

3. Healing: Expect some discomfort for a few days. Soft foods and careful oral hygiene are recommended. Full healing and stable gum margins can take several weeks to months.

4. Restoration/finish-up: Once healed, the restorative treatment (crown or other) can proceed, or the esthetic finishing touches (veneers, contouring) can continue.

5. Maintenance: With good oral hygiene and consistent dental check-ups, long-term success is assured.

Conclusion

At the end of the day, crown lengthening can be used for either functional or aesthetic purposes. Through this surgical procedure, you can improve your smile appearance and tooth functionality, or create space to access a decayed tooth below the gum line. Consult your family dentist in case you wish to repair a decayed tooth or improve the gum and tooth ratio for an aesthetically pleasing smile.